Hepatic Cyst Rupture in a Hemodialysis Patient with Polycystic Kidney Disease

Korean Journal of Nephrology 2008;27(2):256-259.

Ji Eun Kim, M.D., Myung Hee Chang, M.D., Kyoung Hee Jung, M.D., Chang Hwa Lee, M.D., Chong Myung Kang, M.D. and Gheun-Ho Kim, M.D.

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

증례 : 혈액투석 중인 다낭신 환자에서 발생한 간낭종 파열 1예

김지은, 장명희, 정경희, 이창화, 강종명, 김근호

한양대학교 의과대학 내과학교실

Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is usually accompanied with cystic change of other organs, especially in liver. Although hepatic cysts may be presented with abdominal pain or infected cysts, rupture of hepatic cyst is rarely encountered. A 74-year-old female undergoing maintenance hemodialysis for ADPKD-induced end stage renal disease was admitted because of abdominal pain. She recently received intermittent urokinase instillation into her cuffed internal jugular venous catheter. During the admission, a sudden onset of diffuse abdominal pain occurred after hemodialysis and repeated urokinase instillation. The abdominal CT revealed rupture of hepatic cysts with perihepatic fluid collection. With supportive care and heparin-free hemodialysis, symptoms were improved. The abdominal CT taken after 3 weeks showed no evidence of hepatic cyst rupture. The possibility of hepatic cyst rupture should be considered when abdominal pain occurs in dialysis patients with ADPKD. We need to be very cautious when they are exposed to anticoagulants or thrombolytic agents.

Key Words: Polycystic kidney disease, Cyst, Rupture, Hemodialysis